Wednesday, 21 October 2009

It was Friday and once again, our intensive care unit was overfull. We didn’t physically have enough space to accommodate all the people in the hospital who need to be on ventilators. The short-term solution for this common problem was to use the ventilators in the theatre recovery area and to nurse our patients there. This arrangement cannot last too long though as we don’t have enough nurses to properly look after the extra patients and the theatre recovery ventilators are needed for, well, for theatre recovery.

A more permanent solution is to discharge patients from the intensive care unit (ICU) to make space for the extra patients. If they are well enough, sometimes patients can go to the ward, but on Friday we really didn’t have anyone in that position. Our only option was to transfer one of our patients to another ICU in a different hospital where they did happen to have some space.Obviously it’s unfair and unsafe for paramedics to transport these critically ill and unstable patients by themselves, so one what happens is that one of the intensive care doctors and one of the ICU nurses travel with these patients in the ambulance to look after them during the journey, and also to hand over the details of their care to the doctors and nurses in the receiving hospital.

And so it is that I find myself in the back of an ambulance taking one of our patients to another hospital.

Anyone who’s ever taken a ride in the back of an ambulance will tell you that the windows are obscured so you can’t see out. Usually I’m not susceptible to travel sickness, but this day was different. We had the heating up to stop our patient getting cold, the ambulance rocked rolled as we went round corners. I hadn’t been feeling well most of the day, I was tired from being on call the day before and hadn’t eaten very much because I had an upset belly.

It was the speed bumps that really did it for me. Andy, the nurse who was travelling with me said, “You’re being unusually quiet today, Michael.”

I looked at him, but couldn’t seem to focus properly. His features swam before my eyes and I knew then that I was going to spew.

“I feel horrific,” I mumbled. “I’m going to be sick”

He raised an eyebrow. “Really?”

I could only nod because my mouth was filling with saliva and I was holding my breath in an attempt to delay the inevitable long enough to grab a sick bowl.

“Here, take this” said Andy as he quickly pulled a cardboard sick bowl from the pile in which it was stacked.

I accepted it gratefully and promptly vomited into it.

“There he blows!” came the amused voice of the paramedic in the front seat as up came the remnant of my cornflakes and the cup of coffee that I’d had just before leaving. But it didn’t stop there, I spent the next quarter of an hour retching bile as the ambulance zoomed through the city with its blue lights on and the siren going. I hadn’t felt so miserable for ages.

I had never felt so grateful to see another hospital as I did when we pulled up outside the A&E of the receiving hospital and I was able to get out into the fresh air. Our patient was absolutely fine though and on the inter-hospital transfer paper work I wrote “Uneventful transfer” in the comments section and, of course, I made Andy promise not to breathe a word about this to anyone else in the ICU.

9 comments:

I found myself in a similar situation a week ago, only i was transporting a very sick child who extubated himself right after the ambulance started up. I felt nauseated at the end of the trip, was thankful to get back.

"and, of course, I made Andy promise not to breathe a word about this to anyone else in the ICU".Yeah, right! That little story will be told with glee for years to come - sorry!Never mind though, it is only by good luck and quick transfers that more of us have not done the same thing.

I normally don't get travel sick either, but I began feeling a little ill while I was out with LAS the other week (as an observer).

The para was telling me it's because the air suspension makes the back rock and roll around much, much more, especially when you're being blue lighted around. Sitting behind the driver/towards the front tends to solve the motion sickness problem, at least it worked well for me for the rest of the day.

If it makes you feel better, last week I nearly passed out/vomited in a GBMF patient's room because the window heater was on high. And daily my motion sickness makes me nearly vomit in the hospital elevators. My time, too, will come. Sorry yours had to last so long! <3 Fizzle

You know, this is why we invented Critical Care Paramedics (CCPs). In Canada, and other locations CCPs are quite capable of handling ventilated patients as well as central lines, multiple drug infusions, and even IABPs (we have our own IABP to transfer the patient onto, as well as ventilators, pumps, etc. No equipment need leave the hospital). If you don't have CCPs where you are, it might be an idea to start advocating for that program to be introduced. It will help keep your clinical staff in the hospital, and the CCPs caring for your patients will be specialists in inter-facility critical care paramedicine. For some ideas, check out http://www.ornge.ca/index.html

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